One should introduce the following 'interventions' as soon as possible to ensure retention of bone mass and preserve structural integrity of the skeleton, thus preventing fractures.

Bone is a complex tissue that requires essential nutrients for synthesis and maintenance. Good nutrition is essential to normal growth. A balanced diet, adequate calories, and appropriate nutrients are the foundation for development of all tissues including bone.

Calcium and vitamin D are essential to prevent and treat osteoporosis and are adjuncts to preventative therapy (9). Dawson-Hughes (32) showed that non-vertebral fractures in 389 men and women over 65 years were significantly reduced from 26 in the placebo arm to 11 in the calcium - Vitamin D group.

The total of diet and supplemental intake needed is 1500mg calcium/ day. The preferred source of calcium is dietary, but less than 60% of older adults meet this recommendation. About 75% to 80% of the calcium consumed in diets is from dairy products. Calcium supplements need to be absorbable. As we age the body becomes less efficient at absorbing calcium and other nutrients. Vitamin D plays a major role in calcium absorption. Vitamin D3 is preferred at 800 IU/day (9). Chief dietary sources of vitamin D include vitamin D-fortified milk and cereals, egg yolks, saltwater fish, and liver. For detailed information for patients refer to the appended document – "Guidelines for the Prevention of Osteoporosis".

Two studies show that excess caffeine should be avoided (<4 cups/day) (9). Maintaining adequate protein intake (0.8g/kg/day) may be important, especially for those with poor intake (9).

Any man without established osteoporosis should be encouraged to participate in exercise, particularly weight-bearing exercises. Resistance and high impact activities contribute to bone mass and may also reduce the risk of falls in the elderly. During later years exercise combined with calcium and vitamin D probably has a modest effect on slowing the decline in bone mineral density (BMD). Exercise also improves function and delays loss of independence, improving quality of life (QOL) in the elderly (10). Older men at risk of falls need individual assessment and tailored programs to improve strength and balance. Exercise reduces the risk of falls by about 25%, but has not been proven to reduce fracture rates.

Care must be taken in tailoring any exercise in men with established osteoporosis, as falls and high impact may cause fractures. Balance and rehabilitation will help reduce the risk of falls.